When ADHD and Anxiety Occur Together

It’s not uncommon for individuals with attention deficit hyperactivity disorder (ADHD) to struggle with anxiety, whether it’s several symptoms or a full-blown disorder.

In fact, about 30 to 40 percent of people with ADHD have an anxiety disorder, which includes “obsessive-compulsive disorder, generalized anxiety disorder, phobias, social anxiety and panic disorder,” according to Roberto Olivardia, Ph.D, a clinical psychologist and clinical instructor at Harvard Medical School. The Anxiety Disorders Association of America even estimates the figure to be almost 50 percent.

Here’s why ADHD and anxiety co-occur (occur together), how this affects treatment and several strategies for coping with anxiety.

Why ADHD & Anxiety Co-occur

ADHD symptoms can be very intrusive and make life a lot more stressful. For instance, you might miss a critical deadline at work and get fired, forget about your math final and fail the exam or act impulsively and put yourself in danger. Even the fear that you might forget something can keep people continuously worried and anxious.

In other words, “People with ADHD, especially when untreated, are more likely to feel overwhelmed and to have more things fall through the cracks which evokes more frequent negative situations—others are angry with them, they feel disappointed in themselves,” said Ari Tuckman, PsyD, a clinical psychologist and author of More Attention, Less Deficit: Successful Strategies for Adults with ADHD.

People with ADHD tend to be sensitive, which can leave them especially “vulnerable to feeling things more deeply and being more affected by situations and emotions,” Olivardia said.

Genetics also may explain why ADHD and anxiety co-occur. According to Olivardia, there’s good evidence to show that ADHD and OCD have genetic underpinnings. (Here’s one study.) Studies from Massachusetts General Hospital suggest that 30 percent of people with OCD have ADHD.

How Anxiety Affects Treatment

“Anxiety adds another element to ADHD treatment, because you are both developing strategies for the ADHD symptoms and working with the resulting anxiety simultaneously,” Olivardia said.

It also potentially complicates treatment because anxiety can paralyze and leave people stuck in their old ways. As Tuckman said, “People who are anxious are less likely to try new things for fear of them not working out—this includes new strategies to help them get on top of their ADHD.”

Anxiety has another side effect. “We don’t think as clearly when we feel anxious or preoccupied which can add to the ADHD-based distractibility and forgetfulness,” Tuckman said. This can happen particularly with more complex problems, he added.

Also, these symptoms actually might be responses to the medication. According to Tuckman, “the physical sensations of faster heartbeat, dry mouth, etc. are just normal reactions to the medication, just as we would expect that our heart rate would increase after running up a flight of stairs.”

If people can’t tolerate stimulants, psychiatrists may prescribe a non-stimulant along with a selective serotonin reuptake inhibitor (SSRI), which has anxiety-reducing effects. (Tuckman noted that non-stimulants may be less effective than stimulants.)

However, if a person doesn’t want to take several medications, they might decide to medicate one of the disorders and cope with the other behaviorally, Olivardia said.

Also, therapy is very effective for anxiety, said Tuckman, who typically “prefer[s] to address the ADHD first and then see how much of the anxiety shakes out on its own…”

Anxiety-Alleviating Strategies

Understand how your anxiety and ADHD work. Determining how your anxiety functions will help to “inform your treatment,” Olivardia said. “For example, if you found that most of your anxiety was coming from consequences of your ADHD, then the focus of treatment should be the ADHD. If you find they are independent of each other, although are affecting each other, then you want to make sure you are adequately giving each the clinical attention it deserves,” he said.

Minimize worry. Anxious people worry excessively, and these negative thoughts can run your life if you let them. Instead, “Try to come up with alternate explanations or predictions,” Tuckman said. Let’s say your boss was short with you. Instead of thinking that you did something wrong, consider that she’s stressed because of personal reasons, he said. Unless you have a specific reason or actual proof, worrying is needless (and only makes things worse).

He explained that anxiety acts as an alarm that “warns us of danger.” For some people, this alarm is super sensitive. He compared it to a “fire alarm that goes off every time someone burns the toast. It’s bothersome to listen to that alarm go off, but we don’t go running from the building. We check out the situation, see there is nothing to worry about, then go about our business.”

Engage in healthy habits and good self-care. Poor nutrition, lack of sleep and little exercise also fuel anxiety, and ensure you have a shorter fuse when it comes to stress. It’s tremendously helpful to eat nutritious foods, participate in enjoyable physical activities and get enough sleep.

Minimize stress. Olivardia suggested that readers “lower [the] stress in their lives and introduc[e] activities that they enjoy and feel soothed by.”

Both anxiety and ADHD are very treatable with medication and psychotherapy, and there are many effective strategies to manage symptoms and lead a more enjoyable life.

When ADHD and Anxiety Occur Together

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Margarita Tartakovsky, M.S.

Margarita Tartakovsky, M.S. is an Associate Editor and regular contributor at Psych Central. Her Master's degree is in clinical psychology from Texas A&M University. In addition to writing about mental disorders, she blogs regularly about body and self-image issues on her Psych Central blog, Weightless.